Wiki Mutually Exclusive

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gr8gal61

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Am I the only one struggling with the "mutually" exclusive errors received? I am getting a mutually exclusive edit cannot be billed together J02.90 acute pharyngitis& J03.90 acute tonsillitis?

Also B97.89 describes an external cause, code for the first underlying disease. Well the pt comes in with runny nose, cough, fever and the dx the md is using is B97.89 yet no flu swab so do I just need to code the conditions?

Is there a place where I can get mutually exclusive information in laymen terms because I am struggling with it
 
I don't see anything in the guidelines that say you cant bill these together. Unless for some reason pharyngitis is a symptom of tonsillitis?

definition of Mutually Exclusive is:

Code pairs that would not reasonably be performed at the same session and anatomic location for the same patient.

Here is some additional details of bundling and CCI edit's but I think this only really applies to CPT and Not ICD. I believe for ICD-10, its codes listed as Excludes1 that are mutually exclusive.

http://www.aapcps.com/news-articles/bundling-basics.aspx
 
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The mutually exclusive edit means there is an excludes 1 note with one or both codes you are using. You get the excludes 1 notes from looking in the code book. They are typically not in the software.
If you look under the J03 category you will see the exclude 1 note that J03 codes exclude 1 all J02 codes. Exclude1 is a pure exclusion and means they cannot be coded together. Any instructions at the category level apply to all codes in the category.
B97 is a category for other viral diseases as the cause of a disease classified elsewhere. What documentation is the provider using to go with this code? If you just have symptoms then just use symptoms as you do not know if there is a viral disease and what other illness did it cause. I would go with the symptoms unless there is more to the dicumentation.
 
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